MEDICARE: IAN W. HOFFMAN D.D.S. LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1649442344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IAN W. HOFFMAN D.D.S. LTD.

Provider Business Mailing Address
First Line	:	2603 N. MILWAUKEE AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-227-5121
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 N. MILWAUKEE AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-227-5121
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IAN WILLIAM HOFFMAN
Credential	:
Telephone Number	:	773-227-2587

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	04/02/2008

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